Factors Associated with Migration in Individuals Affected by Leprosy, Maranhão, Brazil: An Exploratory Cross-Sectional Study

Abstract

In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil's Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships.

Social determinants of leprosy in a hyperendemic State in North Brazil

“…Most migrants moved from socio-economically deprived regions of high leprosy-endemicity which border the State of Tocantins 2 , 17 , 18 . Migrants usually have greater difficulty accessing health services and more commonly suffer from late diagnosis, poor housing and living conditions, and are unemployed, which define migration as an indicator of poverty and reproduction and distribution of the disease 18 , 19 . The fact that leprosy can be significantly higher for migrants can hinder control measures.…”

Epidemiology and grade 2 disability of leprosy among migrant and resident patients in Guangdong: an unignorable continued transmission of leprosy

“…According to the Guangdong Statistical Yearbook 2021, approximately 28.15 million migrants live in Guangdong province, representing 22.3% of the total permanent population ( 8 ). Movement can be a strategy to achieve a higher standard of living and access to better employment, education, and health service infrastructure, mainly among resource-poor rural areas and urban centers ( 9 ). Migration can lead to changes in circumstances that influence the conditions and risks associated with disease transmission, particularly among the poor, who are disproportionately affected ( 9 , 10 ).…”

“…Movement can be a strategy to achieve a higher standard of living and access to better employment, education, and health service infrastructure, mainly among resource-poor rural areas and urban centers ( 9 ). Migration can lead to changes in circumstances that influence the conditions and risks associated with disease transmission, particularly among the poor, who are disproportionately affected ( 9 , 10 ). Therefore, migration has been identified as one of the social determinants that influence the transmission dynamics of NTDs, including leprosy, which was identified as an infection risk factor associated with poverty ( 11 , 12 ).…”